Laserfiche WebLink
CONTAINER CONSTRUCTION STATE ID NUMBER 00000064450003 <br /> E. ( 1 01 RUBBER LINED ( ) 0�ALKTD INING ( 1 03 EPDXY LINING ( 7 04 PHENOLFC l2NING (X) OS GLASS LINING <br /> 07 UNLINED ( 7 08 ( ) 09 OTHER: <br /> F. ( ] 01 POLYETHLENE WRAP f 1 02 VINYL WRAPPING ( 7 03 CATHODIC PROTECTION (X) 04 UNKNOWN f 1 05 NONE <br /> l ) 06 TAR OR ASPHALT ( ) 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOXES) ( ) 04 PRESSURE f ) 05 SUCTION ( 1 06 UNKNOWN ( 1 07 NONE <br /> B. UNDERGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE f l 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOXES) ( ) 04 PRESSURE (X) 05 SUCTION t ) 06 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTION <br /> ( 1 <br /> 01 VISUAL (X) 02 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS ( 1 05 SENSOR INSTRUMENT <br /> ( ) 06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST (X) 09 NONE ( ) 10 OTHER: <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) <br /> STORED STORED CHEMICAL (00 NOT USE COMMERCIAL NAME) <br /> ( 7 01 ( 7 02 ( ) 03 <br /> ( ) Ol ( 1 02 ( ) 03 <br /> f ) <br /> 01 f ) 02 ( ) 03 <br /> ( ) <br /> al ( ) 02 ( ) 03 <br /> ( 1 01 f ) 02 ( 1 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> f ) 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( ) 01 ( ) 02 f ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> + CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF PERJURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE.AND CORRECT. <br /> PERSON FILI ( ZD NAT E) <br /> PHONE W/AREA CODE <br /> FOR <br /> ♦ ��/� <br /> FOR LOCAL GENCY USE ONLY <br /> ADMINISTRATING <br /> /AGENCY./ / CITY CODE <br /> SA /v �/'\ �( (� / ..�` ` 'A A , COUNTY CODE <br /> CONTACT PERSON �-(/ TlC fi <br /> I PHONE W/AREA CODE V O <br /> _� <br /> DATE OF LAST I ' PECTIO(NV IN COMPLIANCE PERMIT APPROVAL DATE TRANSACTION DATE <br /> OnC ( ) 01 YES ( 102 NO LOCAL PERMIT IO # <br /> 4SC04-070185 (10/18/85) <br /> PAGE 2 <br />